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referrals policy

This policy sets out the procedures we follow for external and internal referrals. In other words, it defines the patient pathways that are followed at hygeia.


Patients attending the practice will usually first be seen by the Clinical Director, Joanne Giddy, for either a new patient consultation, a routine check-up or an emergency consultation. The purpose of these appointments is to allow diagnosis to take place and further action to be agreed with the patient.

There are four possible outcomes (and sometimes a combination of these):

  • Internal referral for restorative or surgical treatment by the Clinical Director, Joanne Giddy;
  • Internal referral for periodontal treatment or preventive advice with the hygienist;
  • External referral for specialist diagnosis and/or treatment by an orthodontist, maxillofacial surgeon or periodontist or for a panoramic x-ray;
  • No immediate treatment.

All four possible outcomes will be followed by a further routine examination at a suitable recall interval.

The GDC removed the barrier to direct access to the services of, among others, dental hygienists.  In view of this change, we now accept new patients to see Debbie, our hygienist, without first seeing a dentist.  Debbie may carry out consultations (including advice on diet, smoking, alcohol consumption and oral hygiene), scaling and root planing (SRP), placement of Periochips, application of Dentomycin, placement of fissure sealants and other treatments for which she has suitable training without the need to first obtain a prescription from a dentist.  Any other dental treatment that Debbie feels may be required must be referred to Joanne Giddy.

Internal referrals

Where a patient is to undergo treatment with the Clinical director, she will, during the course of the examination/consultation, have charted items of planned treatment and have devised a treatment plan in discussion with the patient. She will refer to this treatment plan (plus any intra-oral photographs and x-rays) and will confirm the proposed treatment with the patient prior to commencement of treatment at the next appointment(s).

Where a patient is to undergo treatment with or receive oral hygiene instruction and advice from the hygienist, the necessary information is communicated to the hygienist in much the same manner. The hygienist will refer to the treatment plan and periodontal chart (that will have been prepared by the Clinical Director at the examination) in order to determine what treatment or advice is necessary.

In either case, once periodontal, restorative and/or surgical treatment is complete, an appointment will be made for the patient to return for a routine examination after an appropriate period.

External referrals

Where a patient requires treatment that we are unable to provide, we refer the patient to another professional who specialises in an appropriate area of expertise.

Before referral

The referring clinician must obtain the patient’s consent to make the referral. The patient should understand the reasons for referral, what the treatment may involve and any possible complications that may arise. Before seeing a specialist, the patient should be allowed time to consider the risks involved. At this stage, a further appointment should also be made for the patient to return to the practice for a routine examination following an appropriate interval or alternatively at an earlier date to review the position with the dentist following their external referral.

The referral

A referral should be sent within 14 days of obtaining consent from the patient (save in the case of suspected cancers, which must be sent on the same working day).

The referral should include:

  • The referring dentist’s name
  • The correspondence address, telephone number and email address for the referring dentist (NB: if the referral is by post and is printed on practice headed paper this information is already printed on it)
  • The name, postal address, postcode, telephone number, email address, date of birth and sex of the patient
  • A summary of any relevant medical history (NB allergies, infections)
  • A clear indication of the reasons for the referral together with any specific needs of the patient or any types of treatment that may not be appropriate
  • Copies of any relevant x-rays and intra-oral photographs
  • If the patient is being referred for diagnosis and/or treatment in relation to a medical problem, the duration of the problem should be included together with the patient’s attitude toward or understanding of the situation
  • An indication of whether the patient requires treatment urgently or within a particular time scale
  • Details of anyone acting on the patient’s behalf
  • An indication of whether the referral is being made on a private basis or within the NHS
  • The referral letter should be dated and bear the referring dentist’s signature
  • A copy of the referral should be retained in the patient’s records
  • A copy of the referral should be sent to the patient at the same time that the referral is sent out (and the patient should be provided with the contact telephone number and/or email for the clinician to whom the referral has been sent and an indication of the timescale involved).

Accepting a referral

We do not accept referrals from other practices EXCEPT where we are providing holiday or sickness cover for that practice.  In such situations, we neither request nor expect detailed clinical information but rather just the name and contact information for the person concerned and a brief description of any dental problem that may require attention.  We will approach the patient’s treatment as if they were a new patient of the practice, as detailed above, obtaining all necessary information ourselves.

Emergency situations

Where an emergency situation occurs, such as a medical emergency in the dental surgery that involves the patient losing consciousness, it may be necessary, in order to ensure that the patient’s best interests are served, to share confidential information with other healthcare professionals without first obtaining consent from the patient. The healthcare professionals concerned may be, for example, paramedics or the staff of a hospital emergency medicine department to whom the patient’s ongoing treatment is being referred.

In such cases, the treating dentist may release such information to other healthcare professionals as they consider necessary for the ongoing treatment of the patient. This may be done verbally or in a written format. If information is shared verbally a note should be made (as soon as reasonably practicable) of what information has been released and this should be kept with the patient’s records. Such information may include (though this is not an exhaustive list) their name, address, date of birth, sex, medical history, recent treatment, details of the medical emergency and any first aid given.

Inappropriate sharing of information

Where patient information has been shared inappropriately, it is the responsibility of the Practice Director, Neil Phillips, to undertake an investigation and implement any necessary procedural changes that may be required to avoid a repetition of such inappropriate sharing. The patient must be informed of the fact that their personal data has been shared in an inappropriate manner and should be advised of any measures taken to prevent a repetition of this.

Web version 4: 1.9.2017 (reviewed 11.11.2018)
Previous web versions: 8.2.2011; 27.2.2011 (Reviewed 25.1.2012, 12.3.2013; 19.6.2104; 5.6.2015); 3.8.2016

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